Patients with a limited life expectancy use many medications, some of which may be questionable. Objectives: To identify possible solutions for difficulties concerning medication management and formulate recommendations to improve medication management at the end of life. Methods: A two-round Delphi study with experts in the field of medication management and end-of-life care (based on ranking in the citation index in Web of Science and relevant publications). We developed a questionnaire with 58 possible solutions for problems regarding medication management at the end of life that were identified in previously performed studies. Results: A total of 42 experts from 13 countries participated. Response rate in the first round was 93%, mean agreement between experts for all solutions was 87 % (range 62%-100%); additional suggestions were given by 51%. The response rate in the second round was 74%. Awareness, education and timely communication about medication management came forward as top priorities for guidelines. In addition, solutions considered crucial by many of the experts were development of a list of inappropriate medications at the end of life and incorporation of recommendations for end-of-life medication management in disease-specific guidelines. Conclusions: In this international Delphi study, experts reached a high level of consensus on recommendations to improve medication management in end-of-life care. These findings may contribute to the development of clinical practice guidelines for medication management in end-of-life care.

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Keywords delphi technique, drug utilization review, end-of-life care, medication therapy management, palliative care
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Journal BMJ Supportive and Palliative Care
Huisman, B.A.A, Geijteman, E.C.T, Dees, M, van Zuylen, C, van der Heide, A, & Perez, R.S.G.M. (2018). Better drug use in advanced disease: An international Delphi study. BMJ Supportive and Palliative Care. doi:10.1136/bmjspcare-2018-001623